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People with learning disabilities still face inequalities in access to health services. This article, which comes with a handout for a journal club discussion, sums up what nurses can do to reduce these inequalities

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People with learning disabilities still face inequalities in access to health services. This article, which comes with a handout for a journal club discussion, sums up what nurses can do to reduce these inequalities

Majority of rare cancer cases diagnosed in A&E

People with cancer where the main tumour cannot be found are around twice as likely to be diagnosed in accident and emergency as those with other cancers, figures show.

Data from Public Health England’s National Cancer Intelligence Network (NCIN) found that 57% of cases where the primary tumour was unknown were discovered in A&E or via emergency referral by a GP, compared with 23% for all cancers.

This accounted for around 25,000 cancer cases in England between 2006 and 2010.

Cancer of unknown primary (CUP) is when the origin of the cancer cannot be identified or when NHS staff list it without specifying where it started.

Often, patients have disease that has spread around the body to several organs and investigations have been unable to find the original tumour.

Only 16% of people with CUP are alive one year after diagnosis – which is low compared with most other cancer types.

The new study found that CUPs diagnosed in an emergency lead to lower survival compared with those diagnosed through other routes, such as via a two-week wait system of referral employed by GPs.

Almost 40% of the 44,100 cases of CUP diagnosed in England between 2006 and 2010 were among people aged 80 and over.

Dr Mick Peake, clinical lead of the NCIN, said: “There are many reasons why it is difficult to prove the source of the primary cancer. Sometimes it is just too difficult to get a piece of tissue for analysis but there are some cancers where, despite every test, it is not possible to be sure where the cancer started.”

Sean Duffy, national clinical director for cancer at NHS England, said: “Almost 10% of all cancer cases which presented as emergencies are CUP.

“Currently, referral systems for generic investigation of this rarer form of cancer are poorly developed, which is why we’ve broadened the range of symptoms and enabled more patients to be referred with non-specific symptoms to help increase earlier diagnosis.”

Andrew Wilson, chief executive of the Rarer Cancers Foundation, said: “A diagnosis of cancer can be devastating, but when doctors are unable to find the source of the cancer this can be particularly upsetting for patients and families.

Dr Mike Peake

“We need to do more to ensure these patents not only get the best possible treatment but that the NHS does all that it can to diagnose them earlier.”

Dr Rosie Loftus, joint chief medical officer at Macmillan Cancer Support, said: “This research shows that too many people with rarer cancers are not being recognised until a later stage which reduces their chances of survival.

“When cancer is not diagnosed until someone is admitted to A&E, it is much more difficult to offer them the best treatment options as the disease is often too far advanced.

“We must help to improve the survival rates of people whose primary cancer is unknown.”

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